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J Formos Med Assoc. 2016 Oct 5. pii: S0929-6646(16)30198-X. doi: 10.1016/j.jfma.2016.08.006. [Epub ahead of print]
Long-term outcomes of hepatitis B virus-related cirrhosis treated with nucleos(t)ide analogs.Tsai MC1, Chen CH1, Hu TH1, Lu SN1, Lee CM1, Wang JH1, Hung CH2.
Author information
- 1Division of Hepatogastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
- 2Division of Hepatogastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan. Electronic address: [email protected].
AbstractBACKGROUND/PURPOSE: This study aimed to evaluate the outcomes of chronic hepatitis B patients with cirrhosis who received long-term nucleos(t)ide analog therapy.
METHODS: A total of 546 consecutive cirrhotic patients treated with entecavir (n = 359), telbivudine (n = 104), or tenofovir (n = 83) for chronic hepatitis B were enrolled. The incidence of hepatocellular carcinoma (HCC) and overall survival were evaluated.
RESULTS: During a median follow-up of 39 months, 56 (10.3%) patients developed HCC and 14 (2.6%) patients died. These outcomes were not associated with different antiviral use. Cox proportional hazard analysis showed that old age (≥60 years) [hazard ratio (HR), 1.74; p = 0.046], statin use (HR, 2.42; p = 0.017), low platelet count (<100,000/μL; HR, 2.00; p = 0.039), and variceal bleeding history (HR, 5.12; p < 0.001) were independent factors for HCC development. With regard to survival, Child-Pugh B/C (HR, 3.78; p = 0.039) and low platelet count (<105/μL; HR, 7.82; p = 0.049) were independent factors. The estimated glomerular filtration rate significantly increased in patients receiving telbivudine (p = 0.047), but decreased in those receiving tenofovir (p < 0.001) at Year 2. Tenofovir use (HR, 1.98; p = 0.005) was one of the independent factors associated with the progression of chronic kidney disease stage.
CONCLUSION: Long-term nucleos(t)ide analog therapy does not guarantee against the HCC development and mortality in chronic hepatitis B-related cirrhotic patients. Careful HCC surveillance is necessary in patients with old age, statin use, low platelet count, and variceal bleeding history.
Copyright © 2016. Published by Elsevier B.V.
KEYWORDS: cirrhosis; hepatitis B virus; hepatocellular carcinoma; nucleos(t)ide analogs; survival
PMID:27720344DOI:10.1016/j.jfma.2016.08.006
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